Real Estate Intake Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Marriage Status
Single
Married
Divorced
If divorced, do you have a copy of the Judgment of Divorce?
Yes
No
Type of transaction:
*
Purchase
Sale
Refinance
Short Sale
Foreclosure
Mortgage Loan
Other
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How is the property held on the deed?
Please upload a copy of the deed if you have it
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Number of families
Number of acres
Property Type
Residential
Comm.
Mixed Use
Vacant Lot
Property value in USD
Down payment in USD
Contract price in USD
Loan amount in USD
Liens on property - Lien-holder
Liens on property - Original lien (or mortgage) amount in USD
Liens on property - In foreclosure?
Yes
No
Liens on property - Payment amount in USD?
Do you have a recent appraisal?
Yes
No
Do you have a recent title report?
Yes
No
Do you have a survey?
Yes
No
Do you have an attorney?
Yes
No
Does the other side of the transaction have an attorney?
Yes
No
Do you reside on the property?
Yes
No
Do you reside on the property? - If yes, for how long?
Do you reside on the property? - Do you have a lease?
Yes
No
Do you reside on the property? - Is the property owned in your personal name or in the name of an entity?
Property owned under personal name
Name of an entity
Are you currently employed?
Yes
No
Are you currently employed? - By whom?
Are you currently employed? - Position
Are you currently employed? - Annual salary in USD
Are you currently employed? - Annual salary in USD
Are you currently employed? - How are you employed?
W2
1099
Please upload last 4 pay stubs
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Please upload last 3 months bank statements
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Please provide 2021 and 2022 income taxes
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Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: